The present invention relates to a suturing instrument useful in surgery, and also to a method of applying a suture to tissue during surgery.
Many surgical procedures are presently being performed via an endoscope in order to minimize the size of the incisions and the trauma to the patient. In such procedures, the surgical instrument is generally introduced through a cannula or passageway in the endoscope while the surgeon views the surgical site through another passageway in the endoscope. A number of forceps-type suturing instruments have been designed for introduction through a cannula used in endoscope procedures is a forceps-type suturing instrument, such as disclosed in U.S. Pat. No. 5,730,747 and 6,051,006. The known suturing instruments of this type, however, are generally of relatively complicated construction and/or are useful only with respect to needled sutures.
An object of the present invention is to provide a suturing instrument of relatively simple construction and which can be used with unneedled sutures, i.e., suture threads per se, i.e., without a puncturer being attached to the suture. Another object of the invention is to provide a suturing instrument particularly useful as a forceps type instruments for introduction through a cannula used in endoscopic procedures. A further object of the invention is to provide a novel method of applying a suture to tissue.
According to one aspect of the present invention, there is provided a suturing instrument, comprising: a jaw formed with an opening therethrough; a puncturer pivotally mounted from an open position on one side of the jaw to a closed position through the opening to the opposite side of the jaw, the puncturer being constructed to receive a suture in the open position of the puncturer and to move a portion of the suture through the jaw opening to the opposite side f the jaw when actuated to the closed position of the puncturer; and a crochet head for engaging the portion of the suture at the opposite side of the jaw opening and for clamping the suture to the jaw thereby permitting the puncturer to return to its open position while disengaged from the suture.
According to further features in the preferred embodiment of the invention described below, the crochet head is slidably mounted at the opposite side of the jaw and is movable through a forward stroke from a retracted position at the proximal end of the jaw to an extended position at the distal end of the jaw, and through a return stroke back to the retracted position. The crochet head has a shaped surface effective to engage the portion of the suture at the opposite side of the jaw during the forward stroke of the crochet head, and to clamp same to the jaw during the return stroke of the crochet head.
According to still further features in the described preferred embodiment, the jaw is part of a frame assembly including a proximal section formed with a first handle, and a distal section carrying the jaw; and the puncturer is part of a puncturer assembly including a proximal section formed with a second handle pivotally mounted with respect to the first handle, a distal section including the pivotally mounted puncturer, and a coupling between the second handle and puncturer for pivoting the puncturer from the open position to the closed position upon pivoting the second handle with respect to the first handle. Similarly, the crochet head is part of a crochet head assembly including a proximal section formed with a third handle pivotally mounted with respect to the first handle, a distal section carrying the crochet head, and a coupling for moving the crochet head through its forward and return strokes by the pivoting of the third handle with respect to the first handle.
As will be described more particularly below, the foregoing features enable suturing instruments to be constructed with a relatively few simple parts and to be used unneedled sutures.
According to another aspect of the present invention, there is provided a method of applying a suture to tissue, comprising: pivotally mounting a puncturer with respect to a jaw having an opening therethrough such that the puncturer is pivotal from an open position on one side of the jaw through the opening in the jaw to a closed position on the opposite side of the jaw; applying a suture to the puncturer when the puncturer is in its open position on one side of the jaw; locating the jaw on one side and the pivotal puncturer on the opposite side, of the tissue to be sutured; pivoting the puncturer towards the jaw to pierce the tissue and to pass the puncturer therethrough and through the opening in the jaw to the closed position of the puncturer on the opposite side of the jaw, and thereby to bring a portion of the suture with the puncturer to the opposite side of the jaw; clamping to the jaw the portion of the suture at the opposite side of the jaw; and pivoting the puncturer back to its open position while the suture is clamped to the jaw.
Further features and advantages of the invention will be apparent from the description below.